Nottingham Colorectal Service

Welcome to the Nottingham Colorectal Service. We are a large team of colorectal consultants, colorectal nurse practitioners, clinical nurse specialists, radiologists, oncologists, inflammatory bowel disease nurse specialists and many more. We specialise in caring for patients with benign and malignant large bowel and proctological conditions in Nottingham and its surrounding areas and we work together to maintain the highest possible standards of care for our patients.

We also train the surgeons of the future and have an international reputation for our research. A number of procedures performed in the unit are innovative and not available in other centres. We receive a large number of referrals from other units in the region.

We hope that you find the information on these pages helpful in preparing for, or recovering from, surgery, or simply finding out more about our service.

What we treat

Large bowel cancer

Bowel cancer is the common name we give to cancer that begins in the large bowel. Bowel cancer is the third most common cancer in the UK; there are approximately 40,000 cases every year. The onset of the disease is gradual and symptoms may not be obvious. Common symptoms of bowel cancer include blood in your stools, a change in the pattern and consistency of your stools either to diarrhoea - often with mucous - or to constipation, loss of appetite, unexplained weight loss, tiredness and abdominal (tummy) pain.

These are investigated by a series of endoscopic tests- most often colonoscopy and flexible sigmoidoscopy- and scans. The results of these investigations then dictate the treatment. The treatment often involves surgery. Generally, the affected section of bowel is removed and the ends of the bowel are then joined together. In cases where this is not possible, the end of the bowel is brought through the abdomen to form a new outlet. This is called a stoma.

Surgery is sometimes accompanied by chemotherapy or radiotherapy.

Colitis

Colitis is inflammation of the large or small intestine. There are different forms of colitis: the most common forms are Ulcerative Colitis and Crohn’s Disease. Ulcerative colitis is an inflammation of the lining of the large bowel which most commonly starts in the rectum. Small ulcers can develop which bleed or produce pus. Crohn’s disease is a long term condition that causes inflammation of the lining of the digestive system. It can affect any part of the lining of the digestive tract, which stretches from the mouth to the anus.

The symptoms of colitis include a change in the pattern and consistency of your bowel movements especially to diarrhoea which may contain blood or pus, unexplained weight loss, needing to empty your bowels frequently, abdominal (tummy) pain, bleeding from your back passage and tiredness.

Medical and surgical bowel specialists work jointly to manage these patients. If the symptoms cannot be sufficiently controlled by medication, or persistent symptoms lead to general poor health and complications, then surgical treatment may be necessary.

Diverticular disease

Diverticular disease or diverticulosis is a very common condition mainly of the large bowel. Many people have the disease without realising it because it causes no or few symptoms and causes no harm. Diverticular disease is known to increase with age, occurring in 10% of people in their forties and rising to more than 75% of people in their eighties.

A diverticulum (if there is more than one they are known as 'diverticulae') is a protrusion of the inner lining of the intestine through the outer muscular lining to form a small pouch. The most common site for diverticulae to develop is the left hand side of the colon.

Symptoms of diverticular disease include a change in the pattern and consistency of your bowel movements (more constipated or looser than normal), colicky discomfort particularly on the left side of the abdomen (tummy), distension (swelling) of the abdomen, abdominal pain and blood in the stool.

Once diverticulae have formed they are permanent, but they may not always cause problems. A small portion of symptomatic patients require planned or emergency surgery. There is NO increased risk of cancer if you have diverticular disease but because diverticular disease and cancer can cause similar symptoms your doctor may wish to organise some investigations to exclude cancer.

Anal cancer

The anus is the 4cm long end portion of the large bowel which opens to let solid stool leave the body. Anal cancer is a rare disease affecting around 930 people in the UK each year. Abnormal changes in the anus can lead to cancer. The most common form of anal cancer is squamous cell carcinoma- about 75% (Beating Bowel Cancer, 2014).

Common symptoms of anal cancer include bleeding from your back passage or blood mixed in with the stools, small lumps seen or felt around the anus, anal pain, constipation, feeling the urge to pass stool without production, difficulty controlling your bowels or itching, redness and anal discharge.

Investigations for anal cancer include endoscopy, ultrasound and biopsies (taking small tissue samples for analysis).

Treatment for anal cancer is the dependent on the results and can include radiotherapy +/- chemotherapy, or surgery.

Pelvic floor disorders and faecal incontinence

For some people, opening their bowels to evacuate stool is difficult due to a pelvic floor disorder. Symptoms of pelvic floor disorders include feelings of incomplete evacuation of the rectum and constipation. Incomplete emptying of the rectum may lead to the individual feeling they need to open their bowels multiple times in quick succession. Stool left in the rectum after a bowel movement may seep out leading to complaints of faecal incontinence (American Society of Colon & Rectal Surgeons, 2012).

Sarcoma

Sarcomas are rare cancers that can develop in the muscle, bone, nerve, cartilage and gut, among many other places. The Nottingham Colorectal Service deals with sarcomas that occur in the intestines (Gastro-intestinal stromal tumours, also know as GIST) and inside the abdominal wall (retroperitoneal sarcomas). It is not known why sarcomas develop.

Sarcoma is not in itself painful and therefore is usually detected when it swells and causes discomfort by pushing on other organs, or ruptures causing blood loss and anaemia (Sarcoma UK).

Treatment is usually in the form of surgery to remove the sarcoma.

Intestinal failure

The term intestinal failure describes a group of disorders in which the body is unable to digest and absorb the nutrients, fluids and electrolytes it needs through the intestines. Such disorders include intestinal obstruction, surgery which has removed a large portion of the intestines (particularly the small bowel), problems with motility (the intestines move food through too quickly or too slowly), inherited defects or disease.

The result of intestinal failure is malnutrition and weight loss, diarrhoea and dehydration. Intestinal failure is difficult to treat. Sometimes, patients have to be fed directly in to their veins (parenteral nutrition), or by a tube down into the stomach via the nose (naso-gastric feeding). Other treatments include anti-diarrhoeal medicines, anti-secretory medications and high salt drinks. (NHS England; St Mark’s Hospital).

Complex abdominal wall reconstruction

This is a complex operation to repair weakness in the abdominal wall which is often caused by reoccurring hernias or open chronic wounds. During abdominal wall reconstruction, abdominal tissue is moved around to redistribute the muscle. The surgeon separates each layer of the abdominal wall so that they slide over each other in order to close defects in the abdomen more effectively than simply patching up the gap. As a result, the abdominal wall is strengthened (University of Washington, 2014).